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"Dirty burn” metabolism in alcohol withdrawal syndrome

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Pseudo‐hypoxic dysregulation of glucose metabolism with increased production of lactate and excitatory glutamate in patients with alcohol withdrawal syndrome. Thiamine or magnesium deficiency may compromise thiamine-dependent enzymes and result in altered metabolism of glucose and increased lactate production. In the context of normal tissue oxygen concentrations and in the absence of an inflammatory response or intense skeletal muscle activity, thiamine or magnesium deficiency may produce a pseudo-hypoxic disruption of normal glucose metabolism resulting in increased metabolism of glucose to lactate. (Source: Maguire D, Talwar D, Burns A, et al. A prospective evaluation of thiamine and magnesium status in relation to clinicopathological characteristics and 1-year mortality in patients with alcohol withdrawal syndrome. J Transl Med 2019;17[1]:384. Creative Commons Attribution 4.0 International [CC BY 4.0] license, creativecommons.org/licenses/by/4.0.)